OBJECTIVE: Gastro-oesophageal reflux is a public health concern which could have
associated oesophageal complications, including adenocarcinoma, and possibly also
head-and-neck and lung cancers. The aim of this study was to test the hypothesis
that reflux increases all-cause and cancer-specific mortalities in an unselected
cohort. DESIGN: The Nord-Trondelag health study (HUNT), a Norwegian
population-based cohort study, was used to identify individuals with and without
reflux in 1995-1997 and 2006-2008, with follow-up until 2014. All-cause mortality
and cancer-specific mortality were assessed from the Norwegian Cause of Death
Registry and Cancer Registry. Multivariable Cox regression was used to calculate
HRs with 95% CIs for mortality with adjustments for potential confounders.
RESULTS: We included 4758 participants with severe reflux symptoms and 51 381
participants without reflux symptoms, contributing 60 323 and 747 239
person-years at risk, respectively. Severe reflux was not associated with
all-cause mortality, overall cancer-specific mortality or mortality in cancer of
the head-and-neck or lung. However, for men with severe reflux a sixfold increase
in oesophageal adenocarcinoma-specific mortality was found (HR 6.09, 95% CI 2.33
to 15.93) and the mortality rate was 0.27 per 1000 person-years. For women, the
corresponding mortality was not significantly increased (HR 3.68, 95% CI 0.88 to
15.27) and the mortality rate was 0.05 per 1000 person-years. CONCLUSIONS:
Individuals with severe reflux symptoms do not seem to have increased all-cause
mortality or overall cancer-specific mortality. Although the absolute risk is
small, individuals with severe reflux symptoms have a clearly increased
oesophageal adenocarcinoma-specific mortality.